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General NPI Number Information
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NPI Number | 1568613438
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Entity Type | Organization
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Legal Business Name | PHYSICIANS NETWORK ASSOCIATION
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Dates
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Enumeration Date | 10/09/2008
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Last Update Date | 10/09/2008
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Provider Practice Location Address
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Address Line | 1511 PRESTON ST STISF: MEDICAL DEPARTMENT
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City | HOUSTON
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State | TX
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Zip | 77002-2131
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Country | US
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Telephone | 713-223-0601
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Fax | 713-223-9519
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Provider Business Mailing Address
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Address Line | 1622 MAC DAVIS LN
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City | LUBBOCK
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State | TX
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Zip | 79401-2625
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Country | US
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Telephone | 806-799-1326
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Fax | 806-795-1294
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Authorized Official
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Title or Position | REGIONAL DIRECTOR
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Name | MRS. LARNYA WALKER
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Credential | RN
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Telephone | 832-654-0055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 302R00000X
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License Number State | TX
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